Organ donor management: Eight common recommendations and actions that deserve reflection.

Despite major advances in our understanding of the physiopathology of brain death (BD), there are important controversies as to which protocol is the most appropriate for organ donor management. Many recent reviews on this subject offer recommendations that are sometimes contradictory and in some cases are not applied to other critically ill patients. This article offers a review of the publications (many of them recent) with an impact upon these controversial measures and which can help to confirm, refute or open new areas of research into the most appropriate measures for the management of organ donors in BD, and which should contribute to discard certain established recommendations based on preconceived ideas, that lead to actions lacking a physiopathological basis. Aspects such as catecholamine storm management, use of vasoactive drugs, hemodynamic objectives and monitoring, assessment of the heart for donation, and general care of the donor in BD are reviewed.

First Report of Dolabra nepheliae Associated with Corky Bark Disease of Rambutan and Pulasan in Honduras.

In the last decade, rambutan (Nephelium lappaceum L., Sapindaceae) and pulasan (N. mutabile Blume) have been cultivated in Honduras to produce exotic fruits for export to North America (2). Recently, a disease was observed that produces dark brown to black fissured cankers from 1 to 3 cm long and 1 to 4 cm wide. The infected bark tissue becomes swollen with the middle region 3 to 8 mm thick. Symptoms appear when the trees are approximately 3 years old. As the trees mature, the cankers increase in size and weaken the branches, often resulting in breakage with the weight of the fruit causing substantial plant damage and fruit loss. In August 2010, fissured branch samples of rambutan and pulasan were collected from 6- to 8-year-old trees from the Humid Tropical Demonstrative Agroforestry Center in Honduras, Atlantida, La Masica (15°33'47.4″N, 87°05'2.5″W, elevation 106 m). A fungus associated with the cankers was identified as Dolabra nepheliae. It produces black, stipitate, elongate ascomata, 312 to 482 × 250 to 281 µm with broadly cylindric, bitunicate asci, 120 to 138 × 11.2 to 15.0 µm, and filiform, hyaline ascospores, 128 to 135 × 2.8 to 3.2 µm. Fungi from rambutan and pulasan were isolated on cornmeal agar plus 0.5% dextrose and antibiotics. On potato dextrose agar, the ascospores produced slow-growing colonies, 5 mm per week. In culture, isolates from both hosts produced pycnidia with elongated, slightly to strongly curved or S-shaped, hyaline conidia, 22.8 to 46.4 × 2.8 to 3.7 µm. This fungus was first reported on rambutan and pulasan from Malaysia (1,4), and later reported on rambutan and litchi in Hawaii and Puerto Rico (3). To our knowledge, this is the first report of D. nepheliae on pulasan and rambutan from Honduras. Specimens have been deposited at the U.S. National Fungus Collections (BPI 882442 on N. lappaceum and BPI 882443 on N. mutabile). Cultures were deposited at the Centraalbureau voor Schimmelcultures (CBS) as CBS 131490 on N. lappaceum and CBS 131491 on N. mutabile. Sequences of the internal transcribed spacer (ITS) region including ITS1, 5.8S, and ITS2 intergenic spacers were deposited in GenBank (Accession No. JQ004281 on N. lappaceum and Accession No. JQ004280 on N. mutabile). A BLAST search and pairwise comparison using the GenBank web server were used to compare ITS sequence data and recovered the following results: (i) CBS 131490 on N. lappaceum is 99% (538 of 544) identical to D. nepheliae CBS 123297 on Litchi chinensis from Puerto Rico; and (ii) CBS 131491 on N. mutabile is 99% (527 of 533) identical to the same strain of D. nepheliae. On the basis of the ITS sequence data, the isolates from Honduras were confirmed as the same species, D. nepheliae from Puerto Rico. Efforts to develop resistant germplasm and management strategies to control this disease have been initiated. References: (1) C. Booth and W. P. Ting. Trans. Brit. Mycol. Soc. 47:235, 1964. (2) T. Ramírez et al. Manual Para el Cultivo de Rambutan en Honduras. Fundación Hondureña de Investigación Agrícola. La Lima, Cortes, Honduras, 2003. (3) A. Y. Rossman et al. Plant Dis. 91:1685, 2007. (4) H. Zalasky et al. Can. J. Bot. 49:559, 1971.

First Report of "Candidatus Liberibacter psyllaurous" or "Ca. Liberibacter solanacearum" Associated with Severe Foliar Chlorosis, Curling, and Necrosis and Tuber Discoloration of Potato Plants in Honduras.

From 2006 to 2009, all commercial potato fields in Azacualpa F.M. Honduras were heavily infested with the potato psyllid Bactericera cockerelli (Sulc.). Plants exhibited interveinal chlorosis, vein-greening, downward curling, stunting, above ground tuber formation, and brownish flecks in some tubers. Disease incidence ranged from 50 to 95%. Leaf samples and psyllids were collected from seven fields in two potato-growing regions of Honduras. Total DNA was purified from the leaves of 30 symptomatic and three asymptomatic plants. DNA was extracted from 20 adult and 10 immature (4th to 5th instar) psyllids according to Frohlich et al (1). PCR primers, PSY680F 5'-GTTCGGAATAACTGGGCGTA-3' and PSY1R 5'-CCCATAAGGGCCATGAGGACT-3', were used to amplify a 680-bp fragment of the 16S rDNA for the recently described "Candidatus Liberibacter physallaurous" (2) and "Ca. L. solanacearum" (3). PSY1R/PSY680F primer design was based on the association of a previously undescribed liberibacter with vein-greening symptoms in greenhouse tomato plants in Arizona from 2006 to 2007 (GenBank Accession No. GQ926918) that lead to the hypothesis that a similar bacterium could be associated with symptomatic potato plants in Honduras. PCR amplification, cloning, and sequencing of the resultant 16S rDNA amplicons indicated that 17 of 30 potato plants, 8 of 20 adult and 7 of 10 third to fourth instar psyllids, respectively, were positive for liberibacter based on 99 to 100% shared nucleotide sequence (nt) identity with the analogous sequence from liberibacter (EU812558 [2]). To substantiate these results, a second molecular marker was targeted using the 1611F and 480R primers (~980 bp) that amplify the 16S-23S-ITSrDNA of liberibacter (2) for selected liberibacter-positive samples (above). Amplicons of the expected size were obtained from 12 of 17 potato and 7 of 10 immature psyllids. No PCR product of the expected size was obtained from asymptomatic potato samples or the PCR negative (water) control. The resultant PCR amplicons were cloned and 12 to 15 clones per amplicon were sequenced. The sequences were aligned and the percentage pair wise nt identity was calculated by Clustal W revealing that the 16S rDNA and 16S-23S-ITS sequences, respectively, shared 99 to 100% nt identity with each other. BLAST analysis against the NCBI database indicated that the 16S rRNA sequences from potato plants (GQ926922) and immature psyllids (GQ926923), and the 16S-ITS-23S sequence from potato plants (GQ926924) and immature psyllids (GQ926925), shared 98.5 to 100% nt identity with 'Ca. Liberibacter' reported from potato (EU812556; [2,4]) and tomato (EU812558, EU812559, EU935005; [2,3]). Evidence for the widespread presence of liberibacter and the potato psyllid in potato fields in Honduras, together with foliar and tuber symptoms that are reminiscent of those recently described in potato plants in the United States affected with 'zebra chip' disease (4), suggest that a similar or identical disease of the potato also occurs in Honduras. This emergent disease poses a serious threat to potato production in Honduras and elsewhere in Central America. References: (1) D. R. Frohlich et al., Mol. Ecol. 8:1683, 1999. (2) A. K. Hansen et al. Appl. Environ. Microbiol. 78:5862, 2008. (3) L. W. Liefting et al. Plant Dis. 93:208, 2009. (4) J. E. Munyaneza et al. J. Econ. Entomol. 100:656, 2007.

Los antídotos en su lucha contra las intoxicaciones: a propósito de una intoxicación aguda por arsénico / No disponible

El arsénico es un metal que se encuentra ampliamente distribuido por la naturaleza. Actualmente la mayoría de las intoxicaciones, tanto agudas como crónicas, se ven en el medio laboral, pudiendo darse casos de intoxicación no industrial, a partir de la contaminación de productos domésticos o alimenticios por desechos industriales con arsénico o sus derivados. Sin embargo son excepcionales las intoxicaciones suicidas como el caso que nosotros describimos u homicidas por vía digestiva. En estos casos el tratamiento antídoto, basado en la reactividad química que poseen los agentes quelantes para formar complejos atóxicos e hidrosolubles que se eliminan por la orina, es vital para poder evitar las graves consecuencias incluso letales de dicha intoxicación aguda(AU)

Arsenic is a metal that is widely distributed in nature. Nowadays, most of the poisonings, both acute and chronic, can be seen in the work environment, with some cases of non-industrial contamination reported, caused by contamination of domestic or food products from industrial wastes containing arsenic or its derivatives. Even though, cases of self-poisoning via the digestive tract like the one we describe, or homicide, are exceptional. In these cases, antidotes based on the chemical reactivity owned by the chelating agents to form a non-toxic and water-soluble complex that can be eliminated in urine, are vital to avoid serious or even lethal consequences caused by acute poisoning(AU)

[Monitoring of sedation]. / Monitorización de la sedación.

Once analgesia is assured, sedation has special relevance in the critically ill ventilated patient's global treatment. Sedatives should be adjusted to individual needs, by administering minimal effective doses to achieve the AIM. This aim must be clearly identified, defined at the beginning of the treatment and revised on a regular basis, ideally at least once per shift. Sedation strategies should foresee the different needs throughout the day within dynamic sedation concept framework. Required sedation depth depends on the patient's psychological characteristics, foreseen evolution and patient tolerance to the support techniques used in treatment. Sedation monitoring permits identification and correction of under- or over-sedation, either of which could negatively influence critically ill patient evolution. The over-sedation concept must be applied to all situations where patients receive more sedation than required. This Spanish Society of Critical Care Medicine's Analgesia and Sedation Work Group recommends the Richmond Agitation Sedation Scale, due to its interrelationship with the Confusion Assessment Method Scale (CAM-ICU), for sedation monitoring in patients under light sedation while it recommends bispectral index sedation monitoring in patients under deep sedation. In the latter case, maintaining values under 40 on the bispectral index doesn't produce any benefits except in patients who require a maximum decrease in neuronal metabolism. To avoid recall phenomena, bispectral monitoring is highly advisable in patients treated with neuromuscular blockers.

[Use of neuromuscular blockers in the critical patient]. / Utilización de bloqueantes neuromusculares en el paciente crítico.

The use of neuromuscular blockers (NMB) is a frequent practice in Intensive Care Units. However most of the experience with the use of these agents come from the operating room used to deal with patients with different characteristics from those admitted in the ICU. Recent advances on neuromonitoring and the commercialization of newer agents make necessary the update in the management of NMB in the ICU. The NMB agent should be chosen attending to its pharmacokinetics and the physiopathology of the critically ill patient. Those NMB with organ-independent metabolism as well as those with rapid onset of action are the preferred ones for the use in the critically ill patient substituting older depolarizing agents and those whose metabolism is dependent on the liver and/or kidney, organs frequently impaired in the critically ill patients. Neuromuscular blocking in the critically ill patient should be done according to protocols and monitor its effects in order to avoid complications related to its prolonged use.

Inactivation of Salmonella enterica Ser. Enteritidis in tomato juice by combining of high-intensity pulsed electric fields with natural antimicrobials.

The effect of high-intensity pulsed electric field (HIPEF) treatment (35kV/cm, 4 mus pulse length in bipolar mode without exceeding 38 degrees C) as influenced by treatment time (200, 600, and 1000 micros) and pulse frequency (100, 150, and 200 Hz) for inactivating Salmonella enterica ser. Enteritidis inoculated in tomato juice was evaluated. Similarly, the effect of combining HIPEF treatment with citric acid (0.5%, 1.0%, 1.5%, and 2.0%[wt/vol]) or cinnamon bark oil (0.05%, 0.10%, 0.2%, and 0.3%[vol/vol]) as natural antimicrobials against S. Enteritidis in tomato juice was also studied. Higher treatment time and lower pulse frequency produced the greater microbial inactivation. Maximum inactivation of S. Enteritidis (4.184 log(10) units) in tomato juice by HIPEF was achieved when 1000 micros and 100 Hz of treatment time and pulse frequency, respectively, were applied. However, a greater microbial inactivation was found when S. Enteritidis was previously exposed to citric acid or cinnamon bark oil for 1 h in tomato juice. Synergistic effects were observed in HIPEF and natural antimicrobials. Nevertheless, combinations of HIPEF treatment with 2.0% of citric acid or 0.1% of cinnamon bark oil were needed for inactivating S. Enteritidis by more than 5.0 log(10) units (5.08 and 6.04 log(10) reductions, respectively). Therefore, combinations of HIPEF with organic acids or essential oils seem to be a promising method to achieve the pasteurization in these kinds of products.

Monitorización de la sedación / Monitoring of sedation

Una vez asegurada la analgesia, la sedación adquiere especial relevancia en el tratamiento integral del paciente crítico ventilado. Los sedantes se deben ajustar a las necesidades individuales del paciente, administrando la mínima dosis necesaria para conseguir el objetivo. Este objetivo debe ser claramente identificado, definido al inicio de la terapéutica y revisado de forma regular, idealmente al menos una vez por turno. La estrategia de sedación debe prever las distintas necesidades a lo largo del día, enmarcándose dentro del contexto de la denominada sedación dinámica. La profundidad de sedación necesaria dependerá de las características psicológicas del paciente, de la naturaleza y gravedad de su situación clínica, de la evolución prevista y de su tolerancia a las técnicas de soporte usadas para el tratamiento. La monitorización de la sedación permite identificar y corregir situaciones de infra o sobresedación que pueden influir negativamente en la evolución de los pacientes críticos. El concepto de sobresedación deberá aplicarse a toda aquella situación en la que al paciente se le administre más sedación de la que realmente necesite. La Richmond agitation sedation scale, por su conexión con el Confusion Assessment Method para la Unidad de Cuidados Intensivos (CAM-ICU), es la recomendada por el Grupo de Trabajo para la monitorización de los pacientes con necesidades de sedación no profunda y la monitorización con el análisis biespectral (BIS®) en los que necesitan sedación profunda. En este caso, valores inferiores de 40 en el BIS® no aportan beneficios, salvo en aquellos pacientes en los que se requiera disminuir al máximo el metabolismo neuronal. La monitorización con BIS® es muy recomendable en los pacientes tratados con bloqueo neuromuscular para impedir los fenómenos de recall (AU)

Once analgesia is assured, sedation has special relevance in the critically ill ventilated patient’s global treatment. Sedatives should be adjusted to individual needs, by administering minimal effective doses to achieve the aim. This aim must be clearly identified, defined at the beginning of the treatment and revised on a regular basis, ideally at least once per shift. Sedation strategies should foresee the different needs throughout the day within dynamic sedation concept framework. Required sedation depth de- pends on the patient’s psychological characteristics, foreseen evolution and patient tolerance to the support techniques used in treatment. Sedation monitoring permits identification and correction of under- or over-sedation, either of which could negatively influence critically ill patient evolution. The over-sedation concept must be applied to all situations where patients receive more sedation than required. This Spanish Society of Critical Care Medicine’s Analgesia and Sedation Work Group recommends the Richmond Agitation Sedation Scale, due to its interrelationship with the Confusion Assessment Method Scale (CAM-ICU), for sedation monitoring in patients under light sedation while it recommends bispectral index sedation monitoring in patients under deep sedation. In the latter case, maintaining values under 40 on the bispectral index doesn’t produce any benefits except in patients who re- quire a maximum decrease in neuronal metabolism. To avoid recall phenomena, bispectral monitoring is highly advisable in patients treated with neuromuscular blockers (AU)

Utilización de bloqueantes neuromusculares en el paciente crítico / Use of neuromuscular blockers in the critical pacient

La utilización de bloqueantes neuromusculares (BNM) es una práctica habitual en las Unidades de Cuidados Intensivos. Sin embargo, la experiencia en el uso de estos agentes en el contexto del paciente crítico es limitada, ya que los conocimientos que poseemos derivan del ámbito anestésico, acostumbrado a tratar con pacientes cuya fisiopatología dista mucho de la del paciente ingresado en las Unidades de Cuidados Intensivos. La salida al mercado de nuevos agentes y los avances en la neuromonitorización obligan a un cambio en la pauta de utilización, monitorización y retirada de los BNM. El fármaco utilizado se debe elegir en función de las características fisiopatológicas del paciente y la farmacocinética del BNM. Los agentes de metabolismo órgano-independiente y aquéllos de inicio de acción rápida se perfilan como los más adecuados en el paciente crítico, sustituyendo a los agentes despolarizantes o a aquéllos metabolizados por el hígado y/o el riñón, a menudo con función alterada en estos pacientes. El bloqueo neuromuscular en el paciente crítico debería hacerse de forma protocolizada y con la adecuada monitorización para evitar la aparición de complicaciones asociadas a su uso prolongado (AU)

The use of neuromuscular blockers (NMB) is a frequent practice in Intensive Care Units. However most of the experience with the use of these agents come from the operating room used to deal with patients with different characteristics from those admitted in the ICU. Recent advances on neuromonitoring and the commercialization of newer agents make necessary the update in the management of NMB in the ICU. The NMB agent should be chosen attending to its pharmacokinetics and the physiopathology of the critically ill patient. Those NMB with organ-independent metabolism as well as those with rapid onset of action are the preferred ones for the use in the critically ill patient substituting older depolarizing agents and those whose metabolism is dependent on the liver and/or kidney, organs frequently impaired in the critically ill patients. Neuromuscular blocking in the critically ill patient should be done according to protocols and monitor its effects in order to avoid complications related to its prolonged use (AU)

Salinity tolerance of 'Valencia' orange trees on rootstocks with contrasting salt tolerance is not improved by moderate shade.

The effects of shading in combination with salinity treatments were studied in citrus trees on two rootstocks with contrasting salt tolerance to determine if shading could reduce the negative effects of salinity stress. Well-nourished 2-year-old 'Valencia' orange trees grafted on Cleopatra mandarin (Cleo, relatively salt tolerant) or Carrizo citrange (Carr, relatively salt sensitive), were grown either under a 50% shade cloth or left unshaded in full sunlight. Half the trees received no salinity treatment and half were salinized with 50 mM Cl- during two 9 week salinity periods in the spring and autumn interrupted by an 11 week rainy period. The shade treatment reduced midday leaf temperature and leaf-to-air vapour pressure deficit regardless of salinity treatments. In non-salinized trees, shade increased midday CO2 assimilation rate (A(CO2)) and stomatal conductance, but had no effect on leaf transpiration (E(lf)). Shade also increased leaf chlorophyll and photosynthetic water use efficiency (A(CO2)/E(lf)) in leaves on both rootstocks and increased total plant dry weight in Cleo. The salinity treatment reduced leaf growth and leaf gas exchange parameters. Shade decreased Cl- concentrations in leaves of salinized Carr trees, but had no effect on leaf or root Cl- of trees on Cleo. There were no significant differences in leaf gas exchange parameters of shaded and unshaded salinized plants but the growth reduction from salinity stress was actually greater for shaded than for unshaded trees. Shaded trees on both rootstocks had higher leaf Na+ than unshaded trees after the first salinity period, and this shade-induced elevated leaf Na+ persisted after the second salinity period in trees on Carr. Thus, shading did not alleviate the negative effects of salinity on growth and Na+ accumulation.

First Report of Arceuthobium hondurense in Department El Paraiso, Honduras.

The Honduran dwarf mistletoe, Arceuthobium hondurense Hawksw. & Wiens (Viscaceae), has only been reported from three general areas in Honduras (2). During September 2005, we found a fourth location for this rare dwarf mistletoe south of San Lucas in Department El Paraiso (13°52'58″N, 86°58'04″W; elevation 1,350 m). The mistletoe was parasitizing Pinus oocarpa Schiede, and many trees were severely infected in this area. Several dead trees were also observed with evidence of past dwarf mistletoe infection (witches' brooms). Although this report only extends the distribution approximately 40 km to the southeast of populations of this mistletoe in Department Francisco Morazan, to our knowledge, this is the first report of A. hondurense in Department El Paraiso. At one time, A. hondurense was thought to be in danger of extinction (1), but it is now known from four separate locations in Honduras and has been discovered in a few locations in southern Mexico (2). Nevertheless, this dwarf mistletoe remains one of the rarest mistletoes known. Specimens of A. hondurense from El Paraiso have been deposited at the Deaver Herbarium, Northern Arizona University, Flagstaff (Accession No. 80338). References: (1) F. Hawksworth and D. Wiens. Dwarf mistletoes: Biology, pathology, and systematics. USDA For. Serv. Agric. Handb. 709, 1996. (2) R. Mathiasen et al. Madrono 50:115, 2003.

[Addison's disease: the challenge of an early diagnosis]. / Enfermedad de Addison: el reto de un diagnóstico precoz.

Addison's disease is a set of symptoms which is produced due to the destruction of the suprarenal cortex, of a mainly autoimmune origin, on account of the presence of antibodies which attack it. This destruction takes place in a generally slow manner, causing symptoms to appear in an insidious way, added to the fact that these symptoms tend to be unspecific. Therefore it is easy to understand that its diagnosis at an early stage will be very difficult and is often interpreted as another disease. It is only when the deficit is important and adrenal crisis develop that we can reach the right diagnosis in a situation where the death risk is considerably high. We presented a clinical case as an example of what has been described previously. After several months of progressively deteriorating symptoms and several visits to different medical units, the patient is diagnosed as having an adrenal crisis and is immediately admitted to the intensive care unit.

Enfermedad de Addison: el reto de un diagnóstico precoz / Addison´s disease: the challenge of an early diagnosis

La enfermedad de Addison es un cuadro que se produce debido a la destrucción de la corteza suprarrenal, de origen principalmente auto inmune, por la presencia de anticuerpos contra la misma. Dicha destrucción tiene lugar de forma generalmente muy lenta por lo que la aparición de los síntomas es insidiosa, si añadimos el hecho de que estos síntomas suelen ser inespecíficos, es fácil entender que su diagnóstico en fases precoces sea muy difícil, con frecuencia interpretado como otra entidad clínica y sólo cuando el déficit es importante, dando lugar al desarrollo de las crisis adrenales, llegamos al diagnóstico correcto en una situación en la que el compromiso vital no es nada desdeñable. Presentamos un caso clínico ejemplo de lo anteriormente descrito, en el que tras varios meses de clínica progresiva y varias visitas a distintos servicios médicos, se diagnostica finalmente al presentar una crisis adisoniana que hace necesario su ingreso en una Unidad de Cuidados Intensivos

Addison 's disease is a set of symptoms which is produced due to the destruction of the suprarenal cortex, of a mainly autoimmune origin, on account of the presence of antibodies which attack it. This destruction takes place in a generally slow manner, causing symptoms to appear in an insidious way, added to the fact that these symptoms tend to be unspecific, Therefore it is easy to understand that its diagnosis at an early stage will be very difficult and is often interpreted as another disease, It is only when the deficit is important and adrenal crisis develop that we can reach the right diagnosis in a situation where the death risk is considerably high. We presented a clinical case as an example of what has been described previously, After several months of progressively deteriorating symptoms and several visits to different medical units, the patient is diagnosed as having an adrenal crisis and is immediately admitted to the intensive care unit

Coma mixedematoso: ¿nos hemos olvidado de él? / Myxedema coma: we have forgotten it?

El coma mixedematoso es una situación de hipotiroidismo extremadamente grave, que se caracteriza por tener un pronóstico muy grave con una mortalidad elevada; por ello ha de considerarse una emergencia médica y sospecharlo clínicamente para poder reconocerlo precozmente e instaurar el tratamiento adecuado, preferentemente en una Unidad de Cuidados Intensivos. Presentamos un caso que se corresponde a lo descrito clásicamente en los textos de Medicina y que se pudo resolver con éxito inicialmente, aunque posteriormente presentó una hemorragia cerebral fatal (AU)

Insuficiencia respiratoria aguda que precisa ventilación mecánica: debut de una miastenia gravis / Acute respiratory failure that needs mechanical ventilation: first manifestation of a myasthenia gravis

No disponible

Golpe de calor / Heat stroke

El golpe de calor es una emergencia médica y causa tratable de fracaso multiorgánico (FMO). Se caracteriza por un incremento de la temperatura corporal central por encima de 40ºC y alteraciones del sistema nervioso central donde predomina la encefalopatía y es típico el coma. Es fundamental el diagnóstico precoz y, si no se toman las medidas iniciales oportunas, la tasa de mortalidad es muy alta (hasta el 70%). Las dos formas habituales de presentación son: 1ºen relación con el ejercicio en ambientes calurosos (que afecta fundamentalmente a individuos jóvenes sanos) y 2º la forma clásica (que afecta a ancianos o individuos con enfermedades debilitantes) durante intensas olas de calor. Puede clasificarse dentro de los síndromes inducidos por el calor ambiental y su presentación es consecuencia del fracaso del sistema termorregulador. El tratamiento se basa en el enfriamiento inmediato junto con el soporte de órganos y sistemas (AU)

Heat stroke is a medical emergency and a treatable cause of multiorganicfailure (MOF). It is caracterized by an increase in central bodytemperature (above 40oC) and alterations in the central nervous system where encephalopathy is predominate and comatous states are typical. An early diagnosis is vital and if the right initial measures are not taken the death rate tends to be very high (according to different series arround70%). It is habitually found in two types. Firstly in relation to exercise in hot atmospheres (which affects young healthy people fundamentally) and secondly the more classical situation (which affects young healthly people fundamentally)and secondly the more classical situation (which affects the elderly or people with weakening illnesses) during severe heat weaves. It can be classified within syndromes induced by the heat in the atmosphere and occurs as a consequence of a thermo regulating system failure. The treatment is based on an immediate cooling process and supportive measures view to recovering all organs from their state of insufficiency (AU)

Shock séptico secundario a gangrena de Fournier / Septic shock following Fournier's gangrene

No disponible